The effectiveness of analgesia after total knee replacement
- 作者: Fan U.1, Lychagin A.V1, Gritsyuk A.A1, Smetanin S.M1
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隶属关系:
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- 期: 卷 31, 编号 4 (2020)
- 页面: 75-79
- 栏目: Articles
- URL: https://journals.eco-vector.com/0236-3054/article/view/114213
- DOI: https://doi.org/10.29296/25877305-2020-04-13
- ID: 114213
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详细
Objective. A prospective, randomized, single-center study was conducted involving 160 patients comprising four groups each with 40 people operated on. The patients underwent primary total knee replacement (TKR) under spinal anesthesia. Group 1 underwent periarticular local infiltration anesthesia (LIA); Group 2 had femoral nerve block; Group 3 had popliteal arterial area block; in Group 4 (a control one), multimodal analgesia was used to relieve postoperative pain. Results. The study showed the same level of pain with LIA (Group 1), femoral nerve block (Group 2), and periarterial blockade of the popliteal artery (Group 3); however, the dynamics of quadriceps muscle strength recovery (straight leg lifts) during the first 7 postoperative days were best in Group 1. The Oxford Knee Score (OKS) demonstrated that lower limb function improved significantly in the groups, without a statistically significant difference before and 6 and 12 months after surgery. Conclusion. LIA ensures adequate pain relief in the early postoperative period, which makes it possible to commence early active rehabilitation and to achieve good functional results during primary TKR.
全文:
作者简介
U. Fan
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: drgaamma@gmail.com
A. Lychagin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: drgaamma@gmail.com
MD, Associate Professor
A. Gritsyuk
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: drgaamma@gmail.com
Professor, MD
S. Smetanin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: drgaamma@gmail.com
MD, Associate Professor
参考
- Kerr D., Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients // Acta Orthop. - 2008; 79: 174-83. doi: 10.1080/17453670710014950
- Mayr H., Entholzner E., Hube R. et al. Pre-versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair // Arch. Orthop. Trauma Surg. - 2007; 127: 241-4. doi: 10.1007/s00402-006-0147-0
- Affas F., Nygards E., Stiller C. et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block // Acta Orthop. - 2011; 82: 441-7. doi: 10.3109/17453674.2011.581264
- Chaumeron A., Audy D., Drolet P. et al. Periarticular injection in knee arthroplasty improves quadriceps function // Clin. Orthop. Relat. Res. - 2013; 471: 2284-95. doi: 10.1007/s11999-013-2928-4
- Fu H., Wang J., Zhang W. et al. Potential superiority of periarticular injection in analgesic effect and early mobilization ability over femoral nerve block following total knee arthroplasty // Knee Surg. Sports Traumatol. Arthrosc. - 2017; 25: 291-8. doi: 10.1007/s00167-015-3519-6
- Sakai N., Nakatsuka M., Tomita T. Patient-controlled bolus femoral nerve block after knee arthroplasty: quadriceps recovery, analgesia, local anesthetic consumption // Acta Anaesthesiol. Scand. - 2016; 60: 1461-9. doi: 10.1111/aas.12778
- Li J., Deng X., Jiang T. Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials // J. Orthop. Surg. Res. - 2016; 11 (1): 158 (review). doi: 10.1186/s13018-016-0495-6
- Tanikawa H., Harato K., Ogawa R. et al. Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty // J. Orthop. Surg. Res. - 2017; 12: 109. doi: 10.1186/s13018-017-0616-x
- Stathellis A., Fitz W., Schnurr C. et al. Periarticular injections with continuous perfusion of local anaesthetics provide better pain relief and better function compared to femoral and sciatic blocks after TKA: a randomized clinical trial // Knee Surg. Sports Traumatol. Arthrosc. - 2017; 25 (9): 2702-7. doi: 10.1007/s00167-015-3633-5
- Zhang L., Ma J., Kuang M. et al. Comparison of periarticular local infiltration analgesia with femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials // J. Arthroplasty. - 2018; 33 (6): 1972-8 (review). doi: 10.1016/j.arth.2017.12.042
- Rodriguez-Merchan E. Single Local Infiltration Analgesia (LIA) Aids Early Pain Management After Total Knee Replacement (TKR): an Evidence-Based Review and Commentary // HSS J. - 2018; 14 (1): 47-9 (review). doi: 10.1007/s11420-017-9560-x
- Bohannon R. Measuring knee extensor muscle strength // Am. J. Phys. Med. Rehabil. - 2001; 80 (1): 13-8. doi: 10.1097/00002060-200101000-00004
- Fowler S., Symons J., Sabato S. et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and metaanalysis of randomized trials // Br. J. Anaesth. - 2008; 100: 154-64. DOI: 10.1093/ bja/aem373
- Maempel J., Clement N., Brenkel I. et al. Validation of a prediction model that allows direct comparison of the Oxford Knee Score and American Knee Society clinical rating system // Bone Jt. J. - 2015; 97-B: 503-9.
- Alattas S., Smith T., Bhatti M. et al. Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty // Knee Surg. Sports Traumatol. Arthrosc. - 2016; 25 (11): 3403-10. doi: 10.1007/s00167-016-4314-8
- Wiesmann T., Piechowiak K., Duderstadt S. et al. Continuous adductor canal block versus continuous femoral nerve block after total knee arthroplasty for mobilisation capability and pain treatment: a randomised and blinded clinical trial // Arch. Orthop. Trauma Surg. - 2016; 136 (3): 397-406. doi: 10.1007/s00402-015-2403-7.